Military Health, Tricare programs - Military Times

Tricare Help: Will Tricare cover baby born out of wedlock?

Q. My girlfriend is pregnant with my baby. We will not marry, but I’ll pay child support and health insurance. Since I’m active duty, can the mother get maternity care through Tricare? How do I get Tricare for the baby?

A. Because you and the mother will not be married, she will not be eligible for Tricare. Tricare cannot help her with any of her maternity care.

Federal law does provide Tricare eligibility for your baby, however, if paternity is “judicially” established. That is a legal term. I am not a lawyer, and I am not qualified to say how it applies in a given case. You need legal guidance to do what is needed to enroll your child in Tricare.

Go to the Judge Advocate General office at your base. It provides free legal advice and assistance for active-duty members.

Explain your situation to a JAG officer who is a lawyer, and tell him that the Defense Enrollment Eligibility Reporting System can talk with him about the law that provides Tricare eligibility for a child born out of wedlock. The number for the DEERS Support Office is 800-538-9552. DEERS cannot provide legal help, but it can tell you and the JAG officer what federal law requires.

I don’t know whether you will need a civilian lawyer; see what the JAG officer says. Then, act quickly. Tricare cannot cover any medical care the child receives until he is properly enrolled.

Q. My new employer provides health insurance for employees. Will Tricare let me enroll in it? Will Tricare force me to enroll in it? Can my employer force me to enroll? If I have to pay a premium, will Tricare pay part? Will each policy pay half my medical bills? If not, how much will each one pay?

A. Tricare does not care whether you join your employer’s plan. As far as whether your employer can make you join against your will, you must ask your state Labor Department.

Your premiums depend on the agreement between your employer and the insurance company. The premium buys an insurance policy. The insurance policy pays for the medical care. Tricare may pay for medical care only. It may not pay insurance premiums.

By law, Tricare is always last payer to all other health insurance. The health care provider will issue an itemized bill listing each medical service you received and the charge for it. Your first health insurance will process the claim, then send you a detailed report of what it did with each charge, called an explanation of benefits. Send a copy of both the itemized bill and the explanation of benefits to Tricare. Tricare will pay all or most of what the first insurance did not. It will also send you an EOB with its payment.

Write to Tricare Help, Times News Service, 6883 Commercial Drive, Springfield, VA 22159; or tricarehelp@militarytimes.com. In e-mail, include the word “Tricare” in the subject line and do not attach files. Get more Tricare advice at our Tricare Help blog.